Development of an HPV Educational Protocol for Adolescents

doi:10.1016/j.jpag.2006.12.002

Journal of Pediatric and Adolescent Gynecology

Volume 20, Issue 5, October 2007, Pages 281-287

https://doi.org/10.1016/j.jpag.2006.12.002 Get rights and content

Abstract

Study Objectives

To develop an educational protocol about HPV and Pap tests for adolescents, to evaluate the protocol for understandability and clarity, and to evaluate the protocol for its effectiveness in increasing knowledge about HPV.

Design

In phase 1, investigators and adolescents developed the protocol. In phase 2, adolescents evaluated the protocol qualitatively, investigators evaluated its effectiveness in increasing HPV knowledge in a sample of adolescents, and the protocol was revised. In phase 3, investigators evaluated the effectiveness of the revised protocol in an additional adolescent sample.

Setting

Urban, hospital-based teen health center.

Participants

A total of 252 adolescent girls and boys in the three study phases.

Main Outcome Measures

Pre- and post-protocol knowledge about HPV, measured using a 10- or 11-item scale.

Results

Scores on the HPV knowledge scale increased significantly (P < 0.0001) among adolescents who participated in phases 2 and 3 after they received the protocol. Initial differences in scores based on race, insurance type, and condom use were not noted post-protocol.

Conclusion

The protocol significantly increased knowledge scores about HPV in this population, regardless of sociodemographic characteristics and risk behaviors. Effective, developmentally appropriate educational protocols about HPV and Pap tests are particularly important in clinical settings as cervical cancer screening guidelines evolve, HPV DNA testing is integrated into screening protocols, and HPV vaccines become available. In-depth, one-on-one education about HPV may also prevent adverse psychosocial responses and promote healthy sexual and Pap screening behaviors in adolescents with abnormal HPV or Pap test results.

Introduction

Human papillomavirus (HPV) is one of the most common sexually transmitted infections (STI) in the U.S. Adolescents are at high risk for HPV infection: cumulative prevalence rates up to 82% have been reported in sexually active adolescent girls.¹ Although HPV infection is often transient due to the host immune response, persistent viral replication may lead to genital warts, abnormal Papanicolaou (Pap) tests, cervical dysplasia, and cervical cancer.² Infection with HPV is also associated with vulvar, anal, penile, oropharyngeal, and esophageal carcinomas. A positive test for high-risk (cancer-associated) HPV types is highly sensitive for the detection of cervical dysplasia, due to the etiologic role of HPV in the development of cervical cancer. HPV DNA testing recently has been incorporated into guidelines for primary cervical cancer screening in women older than 30 years of age, and follow-up of adolescent and adult women with abnormal cervical cytology and cervical dysplasia.3, 4, 5, 6, 7, 8

Despite its high prevalence and potentially serious consequences, adolescent and young adult women demonstrate poor understanding of HPV and Pap tests.9, 10, 11, 12, 13, 14 This lack of knowledge may lead to significant psychosocial distress in women diagnosed with HPV or abnormal Pap tests, including fear and anxiety. Research suggests that these types of negative responses could decrease follow-up for diagnostic or treatment procedures.13, 15, 16, 17, 18 Education may prevent or alleviate psychosocial distress by addressing women's concerns about HPV.¹⁹ Finally, HPV vaccines have been developed that target the HPV types most commonly associated with cervical cancer, genital warts, or both. The Food and Drug Administration recently approved an HPV-6,11,16,18 vaccine for use in girls and women 9 to 26 years of age. Although parents will likely be the primary decision-makers regarding vaccination in preadolescents, older adolescents and young women will hold some or all of the responsibility for making decisions about vaccination. Lack of knowledge about HPV may make it difficult for these young women to make appropriate decisions.²⁰

Existing educational materials about HPV and Pap tests generally consist of pamphlets or documents, some of which are available on the internet. These include materials available on the websites of the Centers for Disease Control and Prevention (http://www.cdc.gov/std/HPV/, accessed 12/11/06), the American Social Health Association (http://www.ashastd.org/hpv/hpv_overview.cfm, accessed 12/11/06), the American College of Obstetricians and Gynecologists (http://www.acog.org/departments/dept_notice.cfm?recno=7&bulletin=3097, accessed 12/11/06), and others. These materials can provide basic information about HPV to large numbers of women; however, they are limited in that they cannot provide in-depth information that is individualized to women with specific test results or educational needs. In addition, most resources were developed for adult women, and may not be developmentally appropriate for adolescent populations. Age-appropriate educational protocols are urgently needed for HPV education in clinical or research settings, where one-on-one, interactive counseling occurs both before and after HPV or Pap testing. Furthermore, many women prefer face-to-face interaction with a provider for education about HPV because it ensures privacy, provides an opportunity to ask the provider questions, and enables them to receive information from a trusted, reliable source.¹⁷ Finally, existing information is of varying quality and its effectiveness in increasing knowledge about HPV is largely untested and unknown. Therefore, the aims of this study were: (1) to develop an educational protocol about HPV for adolescents that could be used for individual HPV counseling in clinical or research settings, (2) to evaluate the protocol for understandability and clarity, and (3) to evaluate the protocol for its effectiveness in increasing knowledge about HPV infection and Pap tests.

Section snippets

Materials and Methods

The HPV educational protocol was developed in three phases. Approval was obtained for each phase from the hospital's Institutional Review Board. Written informed consent was obtained from participants ≥ 18 years of age, and from parents of participants who were < 18 years of age. Participants < 18 years of age provided assent to participate.

In phase 1, a group of five experts in adolescent medicine, adolescent gynecology, and HPV (including research faculty, physicians, and nurse practitioners)

Results

The mean age of the participants in phase 2 was 17.8 (SD, 1.9, range 13–21) years. Ninety-eight (82%) of the participants self-identified as black, 15 (13%) as white, and one participant reported Latino ethnicity. Of the 121 adolescents, 90 (74%) reported having Medicaid health insurance, while 19 (16%) reported having private insurance. Mean age of first sexual intercourse was 14.3 (SD 2.0) years and mean number of lifetime sexual partners was 5.7 (SD 5.9). Eighty-four (69%) of the

Discussion

In this study, we developed and tested the effectiveness of a comprehensive, evidence-based HPV educational protocol developed specifically for adolescents. The protocol significantly increased knowledge about HPV among adolescents of varying age, race, and gender. We found that prior to receiving the educational protocol, adolescents had fair knowledge of HPV infection, its transmission, and its consequences. Previous studies similarly have demonstrated that most adolescent and young adult

Acknowledgments

Dr. Kahn is supported by grant #K23AI50923 from the National Institutes of Health, National Institute of Allergy and Infectious Diseases, and grant # RSGPB-04-009-01-CPPB from the American Cancer Society.

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Citation Excerpt :
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Original StudiesDevelopment of an HPV Educational Protocol for Adolescents

Abstract

Study Objectives

Design

Setting

Participants

Main Outcome Measures

Results

Conclusion

Introduction

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

Am J Obstet Gynecol

Prev Med

Obstet Gynecol

J Pediatr Adolesc Gynecol

Prev Med

A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women

J Infect Dis

The causal relation between human papillomavirus and cervical cancer

J Clin Pathol

2001 consensus guidelines for the management of women with cervical cytological abnormalities

JAMA

Interim guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening

Obstet Gynecol

Human papillomavirus testing in primary cervical screening and abnormal Papanicolaou management

Obstet Gynecol Surv

Cervical cancer screening in adolescents

Obstet Gynecol

Evaluation and management of abnormal cervical cytology and histology in the adolescent

Obstet Gynecol

Awareness of human papillomavirus among women attending a well woman clinic

Sex Transm Infect

Making sense of information about HPV in cervical screening: a qualitative study

Br J Cancer

Original Studies
Development of an HPV Educational Protocol for Adolescents